Immunotherapy for environmental allergy

SUBLINGUAL IMMUNOTHERAPY

SLIT is NOT a medication, has no chemicals, is non-GMO – it is an abbreviation for the sublingual immunotherapy. This treatment is similar to the allergy shots, but safer – does not have systemic reactions as a possibility, that is why it can be safely administered at home. Our office successfully treats allergy to pets, dust mites, grasses, trees and weeds with SLIT since 2010. There are high-dose SLIT and low-dose SLIT protocols available – ask Dr Kushnir which therapy is best for you.

Who Should Receive SLIT?

All people who have allergy documented by skin testing and symptoms to PETS OR INDOOR ALLERGENS (CAT, DOG, COCKROACH, MICE, DUST MITES, MOLDS)

All people who have allergy documented by skin testing and symptoms to POLLENS (MOLDS, TREES, GRASSES, WEEDS)

Children from 2 years of age with documented allergy

Pregnant women with significant allergy5. All asthma patients if asthma is allergic (triggered by allergens)

All people who are on medications otherwise not compatible with allergy shots (beta-blockers)

All people who want to receive immunotherapy but cannot fit allergy shots in their busy schedules.

What is Sublingual Immunotherapy?

If you have allergy to any airborne protein (cat, dog, dust mites, molds, pollens or rodents) you can receive biological (no medications or chemicals) treatment to return your immune system into normal function (no allergy) – Immunotherapy.

Sublingual immunotherapy, or SLIT, is a form of immunotherapy that involves putting drops of allergen extracts under the tongue. Many people refer to this process as “allergy drops,” and it is an alternative treatment for allergy shots.

Due to its safety and convenience, this form of immunotherapy has been used for years in Europe, and recently has had increased in the United States. While this method is accepted and covered by medical insurance in European countries, it is not approved by the Food and Drug Administration (FDA) in the United States as treatment. This is the excuse used by medical insurances not to cover this treatment for you. When Dr Kushnir recommends SLIT, It is indeed a medical necessity and approved by Doctor Treatment, so you can use health spending account (HSA) for this expense.

Dr. Kushnir is one of the pioneers of SLIT therapy in the United States. She has invented different modalities of SLIT treatment, including mold SLIT and homeopathic SLIT. She has been successfully treating hundreds of patients over the last 15 years, and will be happy to provide you with individually designed and tailored to fit your needs treatment.

We treat patients from all United States and many countries in Europe. Treatment extracts are mixed based on the skin test results, and can be shipped (overnight FedEx) to your address or to your doctor’s office.

How is it made?

SLIT serum (commercial allergen extracts calculated and mixed by the doctor to a specific concentration individual for you) is diluted in glycerin. Glycerin is chemically neutral for the body, but makes treatment drops stable and protected from bacteria up to 6 months without refrigeration. As such, it becomes a perfect treatment for people who travel – it does not need special refrigeration and can be carried in a purse or travel bag. Note, we do not recommend to check it in on flights, as the only limitation is very high (more than 115F) and very low (freezing) temperature. If serum is frozen or overheated it loses treatment extract and becomes worthless.

How is it administered?

The biggest advantage of SLIT form is its safety – as it does not have potential for systematic anaphylaxis. That is why it can be administered at home and does not require weekly office visits.
SLIT is made in small squeeze-bottles, and used as once a day drops that are placed under the tongue and then swallowed. It is extremely easy and can be done even by small kids (although adult supervision is highly recommended).

SLIT is administered daily over a period of 3-5 years (just like allergy shots). As SLIT is safe, it can be administered at home – that means no missed school or work days!

How Does SLIT Work?

Allergen recognition and attack on airborne proteins start in the nose. It was discovered that immune system of the mouth and gastrointestinal tracts tends to “tolerate” airborne substances, meaning that it does not respond in an “attack” way to swallowed material. This makes sense, otherwise the body would over-react to anything swallowed, including food.

When SLIT is administered under the tongue, the protein is delivered into lymph nodes as “safe”. With that delivery the immune system learns to tolerate the allergen, instead of the over-reactivity of the immune system, as with allergic disease. The results in reduction and disappearance of the allergy symptoms when the body is exposed to the allergy source, such as airborne pollen or pet dander.

How Well Does SLIT Work for allergy and asthma?

SLIT is very effective for the treatment of all airborne allergies and works even for kids down to 2 years old (shots are not recommended until 6-7 years old). It needs to be administered without interruption for prescribed period of time in order to be effective long-term. Big advantage of SLIT – you need to use it only during the allergy season for grasses, trees and weeds, while shots need to be given all year round. For indoor allergens such as cat, dog, cockroach, and dust mite treatment with SLIT is continuous all year round.

What are other health benefits of SLIT?

Remember – SLIT does not decrease immune defense from viruses or bacteria. On contrary, when allergy is treated, it allows immune system to do its normal job – protect you from infections, finding cancer cells in the body and killing them, regenerating brain and body cells (protecting you from dementia, Alzheimer’s, autoimmune diseases and premature aging).

In children we see amazing reduction of the behavioral problems and hyperactivity. Research demonstrated direct link between allergy and ADHD. Parents report improvement of sleep, concentration, and decrease of tantrums and in general, claiming effects within first 3 months of treatment!

Adults notice significant improvement of daily functioning (memory, concentration), better sleep, reduction of snoring and improvement of exercise tolerance. Allergy has been reported as one of the major reasons for sick days and decreased work productivity. Many large companies (such as Google, Facebook) prefer to cover SLIT expense for people who have significant allergies.

What is the Safety of SLIT?

Over the past 10 years, the safety of SLIT has been well documented. To date there are no reports of serious and fatal reactions to SLIT (which is known concern for allergy shots). Mild side effects, such as an itchy mouth, occur in the majority of people at very high doses, and moderate side effects have been documented but extremely rare (1 in about every 12,000 doses), including:

Lips, mouth and tongue itching

Eyes itching, redness and swelling

Nausea, abdominal cramping and diarrhea

Sneezing, nasal itching and congestion

Hives

Because of the safety of SLIT, this treatment can be done at home, and are followed in the clinic at close intervals to monitor response to treatment.

How can I pay for SLIT?

Our office accepts personal check, HSA (health savings account) and cash as a payment. It is always more affordable to subscribe for 12 month if you need continuous treatment. We do not charge percent if you would like a payment plan – just make sure you are paying increments of the total bill on time. Our manager will work with you to apply all discounts and make your personal payment plan. Ask us about the medical credit card application.

ALLERGY INJECTIONS

After we discussed the treatment options for your allergies, it is important you understand what immunotherapy is and how it works. Your decision to start that treatment should be well-thought of and the success depends on your compliance with the regimen for the next 3-5 years. Please do not hesitate to ask questions if this letter does not cover any topics important to you.

Immune system is an internal guard that protects you from intrusion of the “unwanted” proteins. It works against bacteria, viruses and parasites. For some reason (usually genetic), in some people immune system starts reacting to the normal proteins, such as pollen, pet dander, wasp venom, foods. Such abnormal response to the normal environment is called allergy.

About 100 years ago doctors noticed that giving the same “allergic” protein in injections actually restores normal response and allergy disappears. Such treatment was later called immunotherapy. It was extensively studied, and new scientific methods of allergen extracts and allergy injections were developed. Before allergists were making their own extracts and using all kinds of treatment schedules and doses. Now allergists are able to use commercial standard extracts and scientifically supported protocols for allergy injections.

Immunotherapy in general is the only approved biological treatment of allergy (there is no medicine or additive in it; the only active ingredient is allergic protein itself). It is also the only known treatment that actually aborts or significantly reduces allergic reaction in the body – such effect lasts for 10-30 years. All other treatments work only on the symptoms – the effect discontinues as the medicine excreted from the body (usually 12-24 hours). It is important to know that immunotherapy can to prevent the development of asthma or get asthma symptoms under control. It is also effective in reducing your costs for the allergy treatment (does not matter if you use over the counter of prescription meds) in a long run.
Below we summarized the most frequently asked questions that might help you:

Why do I have to get shots? Is there any way to avoid injections? The only FDA approved method of immunotherapy in the US is injections. It works because we “trick” immune system: instead of allergic protein triggering allergy in the nasal membranes, it enters through the skin as through the “back door” where immune cells learn to tolerate it. There is also sublingual method (drops under the tongue) that is safe and effective – it is approved and used extensively in Europe – we can discuss it separately.

Why do I have to be on shots for such a long time? Is there any way to do it faster? There generally are two phases to immunotherapy: build-up and maintenance. During build-up phase, injections will be given 1-3 times a week with increasing amounts of the allergens. This period is 2-6 month depending on the regimen you choose. We can use various schedules that will fit your lifestyle – regimens of “rush” therapy with 2-3 injections per day are available and will reduce the total build-up time. This period is crucial for success of treatment! Please plan the start of shots so there will not be periods longer than 1 week that you will miss between shots. Talk to the Doctor about your plans before you start. Once the maintenance dose is reached, you graduate to the easy-to-follow schedule of 1-2 injections per month which will continue for the next 3-5 years.

Am I the right candidate? Allergy shots can treat patients with allergic asthma, allergic rhinitis/conjunctivitis and stinging insect allergy. Currently they are not approved for food allergies. Your doctor’s recommendation of the allergy shots takes into consideration the following:

Time and lifestyle: immunotherapy requires a major commitment with necessary visits to the doctor’s office on regular basis

Cost: may vary depending on your region and insurance coverage

Remember – in some patients that suffer from other medical conditions or who take certain common medications, allergy shots may be more risky. It is important to mention other medications you take to your allergist.

When Will I Feel Better? When can I stop my medicines? For some people, a decrease in symptoms is seen during the build-up phase; for others, it may take as long as 12 months on the maintenance dose. If there is no improvement after a year of maintenance allergy shots, we suggest repeating skin test and possibly will discuss change of prescription, discontinuation and other treatment options with you.

You need to continue your regular medicines at least for the first 2 month. We will have regular appointments to discuss which medicines you will stop and when – this cannot be predicted and based on your individual responses. Some medicines you will be able to stop abruptly, for some we will use reduction of the dose first.
It is now recommended to use antihistamines every time prior to shots for the best response (research study)

Why I may not respond to immunotherapy?

1. Prescription contains a small dose of the allergen in your vaccine
2. Missing allergens not identified during your allergy testing
3. Levels of the allergen in your environment is too high
4. Your symptoms continue due to major exposure to non-allergic triggers (i.e. tobacco smoke)
5. You have other allergies (food, gluten) that prevent your immune system from proper responses

How do we know when to stop? Once the maintenance dose is reached, effective immunotherapy is recommended to continue for three to five years (based on scientific studies). We will discuss how to test if you already have sufficient response. Some individuals may experience a permanent reduction of their allergy symptoms but others may relapse and a longer course of allergy shots can be considered.

What are the possible side effects? Why do I need to stay in the office for 30 min after each shot?

There are no known side effects; on the contrary some of the symptoms that you were not attributing to the allergy (such as headaches, body aches, and fatigue) may go away with immunotherapy.
As immunotherapy is a biological treatment with something you are allergic to, thus there are two types of adverse reactions that occur with allergy shots. Local reactions are fairly common and occur as redness and swelling at the injection site. This can happen immediately, or several hours after the treatment. Systemic reactions are much less common, are usually mild and typically respond quickly to medications. Signs include increased allergy symptoms such as sneezing, a stuffy nose or hives. Rarely, a serious systemic reaction called anaphylaxis can develop, with swelling in the throat, wheezing, and a feeling of tightness in the chest, nausea or dizziness. Almost all serious systemic reactions develop within 30 minutes of allergy injections – it is strongly recommended you wait in the office for 30 minutes after your injections. Our doctor and staff are trained to watch for such reactions and equipped with the proper medications to identify and treat them.

IMPORTANT POINTS TO REMEMBER

Each antigen plan is individually formulated using your history and skin test results as a guide. In the beginning, injections are given once or twice a week as the strength of the injections builds up to a maximum or maintenance. For most patients this takes approximately six months. Once the maintenance dose is achieved the injections are required less often, usually every two to four weeks. We prepare your antigen for 1 year. Your insurance will be billed every quarter for the part of the payment. By signing this consent you become responsible for the payments determined by your insurance (including deductible, co-pays and any part of the charges that are not covered by your insurance). If you are not aware of your coverage for immunotherapy, please talk to your insurance agent or our office manager prior to signing consent.

It is very important that you continue using you prescribed medications for relief of your allergies and other medical conditions. They will not affect the immunotherapy process. Some medications should not be taken while receiving immunotherapy. Beta blockers such as Corgard, Tenormin, Inderal prescribed for high blood pressure or eye drops used to treat glaucoma should be avoided. Some rare antidepressants such as Nardil, Parnate, or Marplan could also pose a risk to patients on allergy shots. Your physician can discuss this situation with you.
It is very important to keep on schedule when receiving injections. The extracts have expiration dates which can result in wasting of medications if you are not keeping on schedule. Office hours may vary and you should take time to become familiar with these hours and procedures with the office staff. Injections are often unable to be given unless a physician is physically present, so calling ahead if there are questions about an injection will save unnecessary trips.

Whenever you are ill, it is important to notify the office staff so they can determine whether an injection can be given or evaluation is necessary. Injections are not to be received if you have fever or wheezing. Any local discomfort from previous injections should also be reported to the staff. If you are experiencing general increases in your allergies, this should be noted. Do not undertake vigorous physical activity for at least two hours after any allergy injections as this can make an allergic reaction more likely.

Allergic reactions may occur as the result of injections treatment. Most are mild and consist of local swelling, redness, and itching at the injection site. Occasionally large local reactions cause more severe discomfort. These reactions are often treated with ice and antihistamines. There is the possibility of experiencing a systemic (total body) reactions requiring immediate emergency treatment. These reactions occur in about 1 in 10,000 injections and may consist of any or all of the following: itchy eyes, nose or throat; nasal congestion or runny nose; tightness in the chest or throat; coughing wheezing; dizziness or faintness; nausea and vomiting; hives, redness or generalized itching; and rarely shock or loss of consciousness under most extreme conditions. Any of these symptoms should be reported immediately to the doctor or nurse or emergency treatment obtained. Reactions requiring immediate treatment, although unlikely, can be serious and can rarely be life-threatening or even lethal.

Although you are unlikely to experience any difficulty, IT IS IMPORTANT THAT YOU REMAIN IN THE OFFICE FOR 20 MINUTES AFTER RECEIVING AN INJECTION and that you are checked by a nurse or a doctor before leaving. Occasionally a systemic reaction may occur up to several hours after an injection. You should immediately call the office or go directly to the nearest Emergency Room if delayed symptoms.

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DR. NATALIYA M. KUSHNIR, MD / FAAAAI
Dr Nataliya Kushnir received her medical degree with Honors from the European Medical School (Russia) in 1994. She continued her studies and medical research at Stanford. Later she confirmed her degree of the Medical Doctor in the US and completed Residency training by 2002. More>>>

FRISEL LOU, B.A. / MSTCM / L.AC
Acupuncture, energy balancing and herbal treatments are an essential part of our integrative treatment. Meet our wonderful Frisel Lou who is adored by our patients and staff. Even her smile has healing powers! A native of the Philippines, she always had passion for mind and body healing. More>>>